Randomised controlled trial of midwife led debriefing to reduce maternal depression after operative childbirth
Abstract Objective: To assess the effectiveness of a midwife led debriefing session during the postpartum hospital stay in reducing the prevalence of maternal depression at six months postpartum among women giving birth by caesarean section, forceps, or vacuum extraction. Design: Randomised controll...
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| Published in | BMJ Vol. 321; no. 7268; pp. 1043 - 1047 |
|---|---|
| Main Authors | , , , , |
| Format | Journal Article |
| Language | English |
| Published |
London
British Medical Journal Publishing Group
28.10.2000
British Medical Association BMJ Publishing Group LTD BMJ Publishing Group BMJ |
| Edition | International edition |
| Subjects | |
| Online Access | Get full text |
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| Abstract | Abstract Objective: To assess the effectiveness of a midwife led debriefing session during the postpartum hospital stay in reducing the prevalence of maternal depression at six months postpartum among women giving birth by caesarean section, forceps, or vacuum extraction. Design: Randomised controlled trial. Setting: Large maternity teaching hospital in Melbourne, Australia. Participants: 1041 women who had given birth by caesarean section (n= 624) or with the use of forceps (n= 353) or vacuum extraction (n= 64). Main outcome measures: Maternal depression (score ≥13 on the Edinburgh postnatal depression scale) and overall health status (comparison of mean scores on SF-36 subscales) measured by postal questionnaire at six months postpartum. Results: 917 (88%) of the women recruited responded to the outcome questionnaire. More women allocated to debriefing scored as depressed six months after birth than women allocated to usual postpartum care (81 (17%) v 65 (14%)), although this difference was not significant (odds ratio=1.24, 95% confidence interval 0.87 to 1.77). They were also more likely to report that depression had been a problem for them since the birth, but the difference was not significant (123 (28%) v 94 (22%); odds ratio=1.37, 1.00 to 1.86). Women allocated to debriefing had poorer health status on seven of the eight SF-36 subscales, although the difference was significant only for role functioning (emotional): mean scores 73.32 v 78.98, t= −2.31, 95% confidence interval −10.48 to −0.84). Conclusions: Midwife led debriefing after operative birth is ineffective in reducing maternal morbidity at six months postpartum. The possibility that debriefing contributed to emotional health problems for some women cannot be excluded. |
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| AbstractList | Abstract Objective: To assess the effectiveness of a midwife led debriefing session during the postpartum hospital stay in reducing the prevalence of maternal depression at six months postpartum among women giving birth by caesarean section, forceps, or vacuum extraction. Design: Randomised controlled trial. Setting: Large maternity teaching hospital in Melbourne, Australia. Participants: 1041 women who had given birth by caesarean section (n= 624) or with the use of forceps (n= 353) or vacuum extraction (n= 64). Main outcome measures: Maternal depression (score â[per thousand]¥13 on the Edinburgh postnatal depression scale) and overall health status (comparison of mean scores on SF-36 subscales) measured by postal questionnaire at six months postpartum. Results: 917 (88%) of the women recruited responded to the outcome questionnaire. More women allocated to debriefing scored as depressed six months after birth than women allocated to usual postpartum care (81 (17%) v 65 (14%)), although this difference was not significant (odds ratio=1.24, 95% confidence interval 0.87 to 1.77). They were also more likely to report that depression had been a problem for them since the birth, but the difference was not significant (123 (28%) v 94 (22%); odds ratio=1.37, 1.00 to 1.86). Women allocated to debriefing had poorer health status on seven of the eight SF-36 subscales, although the difference was significant only for role functioning (emotional): mean scores 73.32 v 78.98, t = -2.31, 95% confidence interval -10.48 to -0.84). Conclusions: Midwife led debriefing after operative birth is ineffective in reducing maternal morbidity at six months postpartum. The possibility that debriefing contributed to emotional health problems for some women cannot be excluded. Abstract Objective: To assess the effectiveness of a midwife led debriefing session during the postpartum hospital stay in reducing the prevalence of maternal depression at six months postpartum among women giving birth by caesarean section, forceps, or vacuum extraction. Design: Randomised controlled trial. Setting: Large maternity teaching hospital in Melbourne, Australia. Participants: 1041 women who had given birth by caesarean section (n= 624) or with the use of forceps (n= 353) or vacuum extraction (n= 64). Main outcome measures: Maternal depression (score ≥13 on the Edinburgh postnatal depression scale) and overall health status (comparison of mean scores on SF-36 subscales) measured by postal questionnaire at six months postpartum. Results: 917 (88%) of the women recruited responded to the outcome questionnaire. More women allocated to debriefing scored as depressed six months after birth than women allocated to usual postpartum care (81 (17%) v 65 (14%)), although this difference was not significant (odds ratio=1.24, 95% confidence interval 0.87 to 1.77). They were also more likely to report that depression had been a problem for them since the birth, but the difference was not significant (123 (28%) v 94 (22%); odds ratio=1.37, 1.00 to 1.86). Women allocated to debriefing had poorer health status on seven of the eight SF-36 subscales, although the difference was significant only for role functioning (emotional): mean scores 73.32 v 78.98, t= −2.31, 95% confidence interval −10.48 to −0.84). Conclusions: Midwife led debriefing after operative birth is ineffective in reducing maternal morbidity at six months postpartum. The possibility that debriefing contributed to emotional health problems for some women cannot be excluded. Objective To assess the effectiveness of a midwife led debriefing session during the postpartum hospital stay in reducing the prevalence of maternal depression at six months postpartum among women giving birth by caesarean section, forceps, or vacuum extraction. Design Randomised controlled trial. Setting Large maternity teaching hospital in Melbourne, Australia. Participants 1041 women who had given birth by caesarean section (n = 624) or with the use of forceps (n = 353) or vacuum extraction (n = 64). Main outcome measures Maternal depression (score ≥ 13 on the Edinburgh postnatal depression scale) and overall health status (comparison of mean scores on SF-36 subscales) measured by postal questionnaire at six months postpartum. Results 917 (88%) of the women recruited responded to the outcome questionnaire. More women allocated to debriefing scored as depressed six months after birth than women allocated to usual postpartum care (81 (17%) v 65 (14%)), although this difference was not significant (odds ratio = 1.24, 95% confidence interval 0.87 to 1.77). They were also more likely to report that depression had been a problem for them since the birth, but the difference was not significant (123 (28%) v 94 (22%); odds ratio = 1.37, 1.00 to 1.86). Women allocated to debriefing had poorer health status on seven of the eight SF-36 subscales, although the difference was significant only for role functioning (emotional): mean scores 73.32 v 78.98, t = -2.31, 95% confidence interval - 10.48 to - 0.84). Conclusions Midwife led debriefing after operative birth is ineffective in reducing maternal morbidity at six months postpartum. The possibility that debriefing contributed to emotional health problems for some women cannot be excluded. Objective: To assess the effectiveness of a midwife led debriefing session during the postpartum hospital stay in reducing the prevalence of maternal depression at six months postpartum among women giving birth by caesarean section, forceps, or vacuum extraction. Design: Randomised controlled trial. Setting: Large maternity teaching hospital in Melbourne, Australia. Participants: 1041 women who had given birth by caesarean section (n= 624) or with the use of forceps (n= 353) or vacuum extraction (n= 64). Main outcome measures: Maternal depression (score ≥13 on the Edinburgh postnatal depression scale) and overall health status (comparison of mean scores on SF-36 subscales) measured by postal questionnaire at six months postpartum. Results: 917 (88%) of the women recruited responded to the outcome questionnaire. More women allocated to debriefing scored as depressed six months after birth than women allocated to usual postpartum care (81 (17%) v 65 (14%)), although this difference was not significant (odds ratio=1.24, 95% confidence interval 0.87 to 1.77). They were also more likely to report that depression had been a problem for them since the birth, but the difference was not significant (123 (28%) v 94 (22%); odds ratio=1.37, 1.00 to 1.86). Women allocated to debriefing had poorer health status on seven of the eight SF-36 subscales, although the difference was significant only for role functioning (emotional): mean scores 73.32 v 78.98, t= −2.31, 95% confidence interval −10.48 to −0.84). Conclusions: Midwife led debriefing after operative birth is ineffective in reducing maternal morbidity at six months postpartum. The possibility that debriefing contributed to emotional health problems for some women cannot be excluded. OBJECTIVE: To assess the effectiveness of a midwife led debriefing session during the postpartum hospital stay in reducing the prevalence of maternal depression at six months postpartum among women giving birth by caesarean section, forceps, or vacuum extraction. DESIGN: Randomised controlled trial. SETTING: Large maternity teaching hospital in Melbourne, Australia. PARTICIPANTS: 1041 women who had given birth by caesarean section (n= 624) or with the use of forceps (n= 353) or vacuum extraction (n= 64). MAIN OUTCOME MEASURES: Maternal depression (score >/=13 on the Edinburgh postnatal depression scale) and overall health status (comparison of mean scores on SF-36 subscales) measured by postal questionnaire at six months postpartum. RESULTS: 917 (88%) of the women recruited responded to the outcome questionnaire. More women allocated to debriefing scored as depressed six months after birth than women allocated to usual postpartum care (81 (17%) v 65 (14%)), although this difference was not significant (odds ratio=1.24, 95% confidence interval 0.87 to 1.77). They were also more likely to report that depression had been a problem for them since the birth, but the difference was not significant (123 (28%) v 94 (22%); odds ratio=1. 37, 1.00 to 1.86). Women allocated to debriefing had poorer health status on seven of the eight SF-36 subscales, although the difference was significant only for role functioning (emotional): mean scores 73.32 v 78.98, t= -2.31, 95% confidence interval -10.48 to -0.84). CONCLUSIONS: Midwife led debriefing after operative birth is ineffective in reducing maternal morbidity at six months postpartum. The possibility that debriefing contributed to emotional health problems for some women cannot be excluded. OBJECTIVETo assess the effectiveness of a midwife led debriefing session during the postpartum hospital stay in reducing the prevalence of maternal depression at six months postpartum among women giving birth by caesarean section, forceps, or vacuum extraction.DESIGNRandomised controlled trial.SETTINGLarge maternity teaching hospital in Melbourne, Australia.PARTICIPANTS1041 women who had given birth by caesarean section (n= 624) or with the use of forceps (n= 353) or vacuum extraction (n= 64).MAIN OUTCOME MEASURESMaternal depression (score >/=13 on the Edinburgh postnatal depression scale) and overall health status (comparison of mean scores on SF-36 subscales) measured by postal questionnaire at six months postpartum.RESULTS917 (88%) of the women recruited responded to the outcome questionnaire. More women allocated to debriefing scored as depressed six months after birth than women allocated to usual postpartum care (81 (17%) v 65 (14%)), although this difference was not significant (odds ratio=1.24, 95% confidence interval 0.87 to 1.77). They were also more likely to report that depression had been a problem for them since the birth, but the difference was not significant (123 (28%) v 94 (22%); odds ratio=1. 37, 1.00 to 1.86). Women allocated to debriefing had poorer health status on seven of the eight SF-36 subscales, although the difference was significant only for role functioning (emotional): mean scores 73.32 v 78.98, t= -2.31, 95% confidence interval -10.48 to -0.84).CONCLUSIONSMidwife led debriefing after operative birth is ineffective in reducing maternal morbidity at six months postpartum. The possibility that debriefing contributed to emotional health problems for some women cannot be excluded. To assess the effectiveness of a midwife led debriefing session during the postpartum hospital stay in reducing the prevalence of maternal depression at six months postpartum among women giving birth by caesarean section, forceps, or vacuum extraction. Randomised controlled trial. Large maternity teaching hospital in Melbourne, Australia. 1041 women who had given birth by caesarean section (n= 624) or with the use of forceps (n= 353) or vacuum extraction (n= 64). Maternal depression (score >/=13 on the Edinburgh postnatal depression scale) and overall health status (comparison of mean scores on SF-36 subscales) measured by postal questionnaire at six months postpartum. 917 (88%) of the women recruited responded to the outcome questionnaire. More women allocated to debriefing scored as depressed six months after birth than women allocated to usual postpartum care (81 (17%) v 65 (14%)), although this difference was not significant (odds ratio=1.24, 95% confidence interval 0.87 to 1.77). They were also more likely to report that depression had been a problem for them since the birth, but the difference was not significant (123 (28%) v 94 (22%); odds ratio=1. 37, 1.00 to 1.86). Women allocated to debriefing had poorer health status on seven of the eight SF-36 subscales, although the difference was significant only for role functioning (emotional): mean scores 73.32 v 78.98, t= -2.31, 95% confidence interval -10.48 to -0.84). Midwife led debriefing after operative birth is ineffective in reducing maternal morbidity at six months postpartum. The possibility that debriefing contributed to emotional health problems for some women cannot be excluded. Research in Australia on the effectiveness of inpatient debriefing after forceps, caesarian or vacuum extraction. [(BNI unique abstract)] 24 references |
| Author | Lumley, Judith Donohue, Lisa Waldenström, Ulla Small, Rhonda Potter, Anne |
| AuthorAffiliation | a Centre for the Study of Mothers' and Children's Health, School of Public Health, La Trobe University, Carlton Vic 3053, Australia, b Graduate Clinical School of Midwifery and Women's Health, School of Nursing, La Trobe University, c Department of Nursing, Karolinska Institute, Box 286, S-171 77 Stockholm, Sweden |
| AuthorAffiliation_xml | – name: a Centre for the Study of Mothers' and Children's Health, School of Public Health, La Trobe University, Carlton Vic 3053, Australia, b Graduate Clinical School of Midwifery and Women's Health, School of Nursing, La Trobe University, c Department of Nursing, Karolinska Institute, Box 286, S-171 77 Stockholm, Sweden |
| Author_xml | – sequence: 1 givenname: Rhonda surname: Small fullname: Small, Rhonda email: r.small@latrobe.edu.au organization: a Centre for the Study of Mothers' and Children's Health, School of Public Health, La Trobe University, Carlton Vic , Australia – sequence: 2 givenname: Judith surname: Lumley fullname: Lumley, Judith organization: a Centre for the Study of Mothers' and Children's Health, School of Public Health, La Trobe University, Carlton Vic , Australia – sequence: 3 givenname: Lisa surname: Donohue fullname: Donohue, Lisa organization: b Graduate Clinical School of Midwifery and Women's Health, School of Nursing, La Trobe University – sequence: 4 givenname: Anne surname: Potter fullname: Potter, Anne organization: a Centre for the Study of Mothers' and Children's Health, School of Public Health, La Trobe University, Carlton Vic , Australia – sequence: 5 givenname: Ulla surname: Waldenström fullname: Waldenström, Ulla organization: c Department of Nursing, Karolinska Institute, Box , S- Stockholm, Sweden |
| BackLink | http://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=1521121$$DView record in Pascal Francis https://www.ncbi.nlm.nih.gov/pubmed/11053173$$D View this record in MEDLINE/PubMed http://kipublications.ki.se/Default.aspx?queryparsed=id:11545462$$DView record from Swedish Publication Index |
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| ContentType | Journal Article |
| Copyright | 2000 BMJ Publishing Group Ltd. Copyright 2000 BMJ 2000 INIST-CNRS Copyright: 2000 (c) 2000 BMJ Publishing Group Ltd. Copyright British Medical Association Oct 28, 2000 Copyright © 2000, BMJ 2000 |
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| DOI | 10.1136/bmj.321.7268.1043 |
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| Discipline | Medicine |
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| Keywords | Mood disorder Human Health promotion Depression Delivery Puerperium Midwife |
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| Notes | PMID:11053173 istex:FDD997A291D701C6D63F8D254F92D8B73E05040D ArticleID:bmj.321.7268.1043 Correspondence to: R Small ark:/67375/NVC-C3290TG6-7 local:bmj;321/7268/1043 href:bmj-321-1043.pdf ObjectType-Article-2 SourceType-Scholarly Journals-1 ObjectType-Feature-1 content type line 23 ObjectType-Undefined-3 Contributors: RS drafted the grant application for the study, participated jointly in protocol design and discussion of core ideas at research team meetings, was the principal investigator for the study in its final two years, conducted the data analysis, and drafted the paper. JL initiated the study, formulated the research questions, contributed to the grant application, participated jointly in protocol design and discussion of core ideas at research team meetings, and contributed to the writing of the paper. LD contributed to the grant application and protocol design, undertook recruitment and conducted the debriefing intervention, participated in data collection and discussion of core ideas at research team meetings, and contributed to the paper. AP contributed to protocol design, undertook recruitment and conducted the debriefing intervention, participated in data collection and discussion of core ideas at research team meetings, coded all the questionnaires, and contributed to the paper. UW participated jointly in protocol design and discussion of core ideas at research team meetings, was the principal investigator for the study in its first two years, and contributed to the paper. Correspondence to: R Small r.small@latrobe.edu.au |
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| References | Elliott 1984; 2 O'Hara, Swain 1996; 8 Cox, Holden, Sagovsky 1987; 150 Wessely 1998; 25 MacArthur, Lewis, Knox 1991; 98 Bisson, Deahl 1994; 165 Ware, Sherbourne 1992; 30 Hillan 1992; 19 Lavender, Walkinshaw 1998; 25 Lee, Slade, Lygo 1996; 69 Ralph, Alexander 1994; 90 Hobbs, Mayou, Harrison, Worlock 1996; 313 Conlon, Fahy, Conroy 1999; 46 Nott 1987; 151 Fisher, Stanley, Burrows 1990; 11 Raphael, Meldrum 1995; 310 Astbury, Brown, Lumley, Small 1994; 18 Bisson, Jenkins, Alexander, Bannister 1997; 171 Brown, Lumley 1998; 105 11187945 - BMJ. 2000 Dec 9;321(7274):1470 ACP J Club. 2001 May-Jun;134(3):86 11053152 - BMJ. 2000 Oct 28;321(7268):1032-3 11302918 - BMJ. 2001 Apr 14;322(7291):928 11302913 - BMJ. 2001 Apr 14;322(7291):929 11302920 - BMJ. 2001 Apr 14;322(7291):928; author reply 929 |
| References_xml | – volume: 2 start-page: 18 year: 1984 article-title: Relationship between obstetric outcome and psychological measures in pregnancy and the postnatal year. publication-title: J Reprod Inf Psychol contributor: fullname: Elliott – volume: 150 start-page: 782 year: 1987 article-title: Detection of postnatal depression: development of the 10-item Edinburgh postnatal depression scale. publication-title: Br J Psychiatry contributor: fullname: Sagovsky – volume: 171 start-page: 78 year: 1997 article-title: Randomised controlled trial of psychological debriefing for victims of acute burn trauma. publication-title: Br J Psychiatry contributor: fullname: Bannister – volume: 310 start-page: 1479 year: 1995 article-title: Does debriefing after psychological trauma work? publication-title: BMJ contributor: fullname: Meldrum – volume: 8 start-page: 37 year: 1996 article-title: Rates and risk of postpartum depressiona meta-analysis. publication-title: Int Rev Psychiatry contributor: fullname: Swain – volume: 98 start-page: 1193 year: 1991 article-title: Health after childbirth. publication-title: Br J Obstet Gynaecol contributor: fullname: Knox – volume: 11 start-page: 91 year: 1990 article-title: Psychological adjustment to caesarean delivery: a review of the evidence. publication-title: J Psychosom Obstet Gynaecol contributor: fullname: Burrows – volume: 165 start-page: 717 year: 1994 article-title: Psychological debriefing and prevention of post-traumatic stress: more research is needed. publication-title: Br J Psychiatry contributor: fullname: Deahl – volume: 18 start-page: 176 year: 1994 article-title: Birth events, birth experiences and social factors in depression after birth publication-title: Aust J Public Health contributor: fullname: Small – volume: 105 start-page: 156 year: 1998 article-title: Maternal health after childbirth: results of an Australian population based survey. publication-title: Br J Obstet Gynaecol contributor: fullname: Lumley – volume: 46 start-page: 37 year: 1999 article-title: PTSD in ambulant RTA victims: a randomized controlled trial of debriefing. publication-title: J Psychosom Res contributor: fullname: Conroy – volume: 69 start-page: 47 year: 1996 article-title: The influence of psychological debriefing on emotional adaptation of women following early miscarriage: A preliminary study. publication-title: Br J Med Psychol contributor: fullname: Lygo – volume: 151 start-page: 523 year: 1987 article-title: Extent, timing and persistence of emotional disorders following childbirth. publication-title: Br J Psychiatry contributor: fullname: Nott – volume: 19 start-page: 190 year: 1992 article-title: Short-term morbidity associated with caesarean delivery. publication-title: Birth contributor: fullname: Hillan – volume: 90 start-page: 28 year: 1994 article-title: Borne under stress. publication-title: Nursing Times contributor: fullname: Alexander – volume: 30 start-page: 473 year: 1992 article-title: The MOS 36-item short-form health survey (SF-36). 1. Conceptual framework and item selection. publication-title: Med Care contributor: fullname: Sherbourne – volume: 313 start-page: 1438 year: 1996 article-title: Randomised controlled trial of psychological debriefing for victims of road traffic accidents. publication-title: BMJ contributor: fullname: Worlock – volume: 25 start-page: 220 year: 1998 article-title: Commentary: reducing distress after normal childbirth. publication-title: Birth contributor: fullname: Wessely – volume: 25 start-page: 215 year: 1998 article-title: Can midwives reduce postpartum psychological morbidity? A randomized trial. publication-title: Birth contributor: fullname: Walkinshaw |
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| Snippet | Abstract Objective: To assess the effectiveness of a midwife led debriefing session during the postpartum hospital stay in reducing the prevalence of maternal... Objective: To assess the effectiveness of a midwife led debriefing session during the postpartum hospital stay in reducing the prevalence of maternal... Objective To assess the effectiveness of a midwife led debriefing session during the postpartum hospital stay in reducing the prevalence of maternal depression... To assess the effectiveness of a midwife led debriefing session during the postpartum hospital stay in reducing the prevalence of maternal depression at six... OBJECTIVE: To assess the effectiveness of a midwife led debriefing session during the postpartum hospital stay in reducing the prevalence of maternal... OBJECTIVETo assess the effectiveness of a midwife led debriefing session during the postpartum hospital stay in reducing the prevalence of maternal depression... Research in Australia on the effectiveness of inpatient debriefing after forceps, caesarian or vacuum extraction. [(BNI unique abstract)] 24 references |
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| SubjectTerms | Adult Adult and adolescent clinical studies Attitude to Health Biological and medical sciences Births Cesarean Section - psychology Childbirth Childbirth & labor Counseling Crisis Intervention - methods Data collection Delivery. Postpartum. Lactation Depression Depression, Postpartum - nursing Depression, Postpartum - prevention & control Depressive disorders Experimentation Extraction, Obstetrical - psychology Female Gynecology. Andrology. Obstetrics Health status Humans Maternal & child health Maternal, fetal and perinatal monitoring Medical sciences Medicin och hälsovetenskap Meetings Mental depression Midwifery Mood disorders Morbidity Mothers Mothers - psychology Nurse Midwives Obstetrical Forceps Odds Ratio Patient Satisfaction Postpartum depression Postpartum period Pregnancy Prognosis Psychological trauma Psychology. Psychoanalysis. Psychiatry Psychopathology. Psychiatry Questionnaires Self esteem Studies Teaching hospitals Womens health |
| Title | Randomised controlled trial of midwife led debriefing to reduce maternal depression after operative childbirth |
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